Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0256 | NV |
N | 152WP0200X | Pediatric Optomitrist | 0256 | NV |
N | 152WX0102X | Occupational Vision | 0256 | NV |
NPI | 1255327011 |
---|---|
Provider Name | Dr. Conrad Lochner III |
First Address | Henderson, NV 89012-4477 |
Second Address | Nellis Afb, NV 89191-7052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 30/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U24854 | (02) | NV |